The Relative Importance of Quality of Care Information When Choosing a Hospital for Surgical Treatment: A Hospital Choice Experiment

Department of Medical Decision Making, Leiden University Medical Center, the Netherlands.
Medical Decision Making (Impact Factor: 3.24). 11/2011; 31(6):816-27. DOI: 10.1177/0272989X11386799
Source: PubMed


To assess the impact of quality of care and other hospital information on patients' choices between hospitals.
665 former surgical patients were invited to respond to an Internet-based questionnaire including a choice-based conjoint analysis. Each patient was presented with 12 different comparisons of 2 hospitals, with each hospital characterized by 6 attributes containing 2 levels. Hospital attributes were included if frequently reported by patients as most important for future hospital choices. These included both general hospital information (e.g., atmosphere), information on quality of care (e.g., percentage of patients with "textbook outcome"), and surgery-specific information (e.g., possibility for minimally invasive procedure). Hierarchial Bayes estimation was used to estimate the utilities for each attribute level for each patient. Based on the ranges of these utilities, the relative importance of each hospital attribute was determined for each participant as a measure of the impact on patients' choices.
308 (46.3%) questionnaires were available for analysis. Of the hospital attributes that patients considered, surgery-specific information on average had the highest relative importance (25.7 [23.9-27.5]), regardless of gender, age, and education. Waiting time and hospital atmosphere were considered least important. The attribute concerning the percentage of patients with "textbook outcomes" had the second greatest impact (18.3 [16.9-19.6]), which was similar for patients with different adverse outcome experience.
Surgery-specific and quality of care information are more important than general information when patients choose between hospitals.

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    • "Several studies (n = 10) found a positive relationship between the level of education and the importance attached to outcome characteristics [28,33,67,113,119,124]. Patients with more complex or severe diseases attach less importance to outcome characteristics (n = 2) [29,113] and the specific disease influences the importance that the patient attaches to outcome characteristics (n = 7) [30,33,45,46,98,119]. "
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    ABSTRACT: Background In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results Our review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.
    BMC Health Services Research 08/2012; 12(1):272. DOI:10.1186/1472-6963-12-272 · 1.71 Impact Factor
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    • "Short distance to hospital was the most important factor behind GPs’ choice of hospital. Numerous other studies of GPs’ actual referral pattern and patients’ choices in structurally different health care systems likewise indicate that short distance strongly influences patients’ and GPs’ choice of hospital [26,33,42]. Studies of GPs’ hypothetical referrals and patients’ hypothetical choices have led to other results with GPs emphasizing the importance of short waiting time and the GP’s impression of quality at the alternative departments [35,43], while patients facing a hypothetical choice emphasized the importance of data on structure quality and attributed little weight to waiting time [44]. "
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    ABSTRACT: Parts of New Public Management-reforms of the public sector depend on introduction of market-like mechanisms to manage the sector, like free choice of hospital. However, patients may delegate the choice of hospital to agents like general practitioners (GPs). We have investigated which factors Danish GPs reported as decisive for their choice of hospital on behalf of patients, and their utilisation of formal and informal data sources when they chose a hospital on behalf of patients. Retrospective questionnaire study of all of the 474 GPs practising in three counties which constituted a single uptake area. Patients were free to choose a hospital in another county in the country. The GPs were asked about responsibility for choice of the latest three patients referred by the GP to hospital; which of 16 factors influenced the choice of hospital; which of 15 sources of information about clinical quality at various hospitals/departments were considered relevant, and how often were six sources of information about waiting time utilised. Fifty-one percent (240 GPs) filled in and returned the questionnaire. One hundred and eighty-three GPs (76%) reported that they perceived that they chose the hospital on behalf of the latest referred patient. Short distance to hospital was the most common reason for choice of hospital.The most frequently used source of information about quality at hospital departments was anecdotal reports from patients referred previously, and the most important source of information about waiting time was the hospitals' letters of confirmation of referrals. In an area with free choice of public hospital most GPs perceived that they chose the hospital on behalf of patients. Short distance to hospital was the factor which most often decided the GPs' choice of hospital on behalf of patients. GPs attached little weight to official information on quality and service (waiting time) at hospitals or departments, focusing instead on informal sources like feedback from patients and colleagues and their experience with cooperation with the department or hospital.
    BMC Health Services Research 05/2012; 12(1):126. DOI:10.1186/1472-6963-12-126 · 1.71 Impact Factor
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    • "Instead, in a choice experiment respondents are forced to make a trade-off between two or more options. We have previously shown this to be a feasible approach in surgical patients [12]. Recently, Sawtooth Software developed a new approach called Adaptive CBC (ACBC) [13]. "
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    ABSTRACT: Public information on average has limited impact on patients' hospital choice. However, the impact may be greater in consumers who have compared hospitals prior to their hospital choice. We therefore assessed whether patients who have compared hospitals based their hospital choice mainly on public information, rather than e.g. advice of their general practitioner and consider other information important than patients who have not compared hospitals. 337 new surgical patients completed an internet-based questionnaire. They were asked whether they had compared hospitals prior to their hospital choice and which factors influenced their choice. They were also asked to select between four and ten items of hospital information (total: 41 items) relevant for their future hospital choice. These were subsequently used in a hospital choice experiment in which participants were asked to compare hospitals in an Adaptive Choice-Based Conjoint analysis to estimate which of the hospital characteristics had the highest Relative Importance (RI). Patients who have compared hospitals more often used public information for their hospital choice than patients who have not compared hospitals (12.7% vs. 1.5%, p < 0.001). However, they still mostly relied on their own (47.9%) and other people's experiences (31%) rather than to base their decision on public information. Both groups valued physician's expertise (RI 20.2 [16.6-24.8] in patients comparing hospitals vs. 16.5 [14.2-18.8] in patients not comparing hospitals) and waiting time (RI 15.1 [10.7-19.6] vs. 15.6 [13.2-17.9] respectively) as most important public information. Patients who have compared hospitals assigned greater importance to information on wound infections (p = 0.010) and respect for patients (p = 0.022), but lower importance to hospital distance (p = 0.041). Public information has limited impact on patient's hospital choice, even in patients who have actually compared hospitals prior to hospital choice.
    BMC Health Services Research 09/2011; 11(1):214. DOI:10.1186/1472-6963-11-214 · 1.71 Impact Factor
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